Anemia,IronStatus,andHIV:ASystematicReview oftheEvidence

Abstract

People living with HIV (PLWHIV) are at high risk of anemia due to inadequate iron intake, HIV and opportunistic infections, and inflammation, and as a side effect of antiretroviral therapy. Though iron supplementation can reduce iron deficiency anemia (IDA) in the general population, its role inanemiaandinthehealthofPLWHIVisunclearduetoconcernsthatironsupplementationmayincreaseHIVreplicationandriskofopportunistic infections.Wesystematicallyreviewedtheevidenceonindicatorsofironstatus,ironintake,andclinicaloutcomesamongadultsandchildrenwith HIV. The evidence suggests that anemia is associated with an increased risk of all-cause mortality and incident tuberculosis among HIV-infected individuals, regardless of anemia type, and the magnitude of the risk is greater with more severe anemia. High serum ferritin is associated with adverseclinicaloutcomes,althoughitisunclearifthisisduetohighironorinflammationfromdiseaseprogression.Onelargeobservationalstudy found an increased risk of all-cause mortality among HIV-infected adults if they received iron supplementation. Published randomized controlled trialsofironsupplementationamongPLWHIVtendtohavesmallsamplesizesandhavebeeninconclusiveintermsofeffectivenessandsafety.Large randomized trials exploring approaches to safely and effectively provide iron supplementation to PLWHIV are warranted